Healthcare Provider Details

I. General information

NPI: 1942637103
Provider Name (Legal Business Name): DEBORAH LOCKE PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2013
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9920 S RURAL RD # A-108
TEMPE AZ
85284-4100
US

IV. Provider business mailing address

261 N ROOSEVELT AVE
CHANDLER AZ
85226-2617
US

V. Phone/Fax

Practice location:
  • Phone: 480-677-8282
  • Fax: 888-316-1686
Mailing address:
  • Phone: 480-677-8282
  • Fax: 888-316-1686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number5493
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number016897-1
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5493
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: